Left Atrial Appendage Closure with Amplatzer Cardiac Plug in Nonvalvular Atrial Fibrillation: Safety and Long-Term Outcome / Oclusão Percutânea do Apêndice Atrial Esquerdo com Amplatzer Cardiac Plug na Fibrilação Atrial não Valvar: Análise de Segurança e Resultados de Longo Prazo

Abstract Background: Atrial fibrillation (AF) is a cardiac arrhythmia with high risk for thromboembolic events, specially stroke. Objective: To assess the safety of left atrial appendage closure (LAAC) with the Amplatzer Cardiac Plug for the prevention of thromboembolic events in patients with nonvalvular AF. Methods: This study included 15 patients with nonvalvular AF referred for LAAC, 6 older than 75 years (mean age, 69.4 ± 9.3 years; 60% of the male sex). Results: The mean CHADS2 score was 3.4 ± 0.1, and mean CHA2DS2VASc , 4.8 ± 1.8, evidencing a high risk for thromboembolic events. All patients had a HAS-BLED score > 3 (mean, 4.5 ± 1.2) with a high risk for major bleeding within 1 year. The device was successfully implanted in all patients, with correct positioning in the first attempt in most of them (n = 11; 73.3%). Conclusion: There was no periprocedural complication, such as device migration, pericardial tamponade, vascular complications and major bleeding. All patients had an uneventful in-hospital course, being discharged in 2 days. The echocardiographic assessments at 6 and 12 months showed neither device migration, nor thrombus formation, nor peridevice leak. On clinical assessment at 12 months, no patient had thromboembolic events or bleeding related to the device or risk factors. In this small series, LAAC with Amplatzer Cardiac Plug proved to be safe, with high procedural success rate and favorable outcome at the 12-month follow-up. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Resumo Fundamento: Fibrilação atrial (FA) é uma arritmia cardíaca que submete os pacientes a alto risco de eventos tromboembólicos, particularmente o acidente vascular encefálico. Objetivo: Avaliar a segurança da oclusão do apêndice atrial esquerdo (OAAE) com o dispositivo Amplatzer Cardiac Plug na prevenção de fenômenos embólicos em pacientes com FA de origem não valvar. Métodos: Este estudo de OAAE incluiu 15 pacientes, sendo 6 (40%) acima de 75 anos (idade média, 69,4 ± 9,3 anos; 60% do sexo masculino). Resultados: A média do escore CHADS2 foi 3,4 ± 0,1. Quando se aplicou o CHA2DS2VASc, a média foi de 4,8 ± 1,8, mostrando alto risco de eventos tromboembólicos. Todos os pacientes tinham o escore HAS-BLED > 3 (média 4,5 ± 1,2) com alto risco de sangramentos maiores em 1 ano. Houve sucesso no implante do dispositivo em todos os pacientes, com posicionamento correto na primeira tentativa na maioria deles (n = 11; 73,3%). Conclusão: Não houve complicações periprocedimento, como migração do dispositivo, tamponamento pericárdico, complicações vasculares e hemorragias maiores. Na fase intra-hospitalar, os pacientes evoluíram favoravelmente, obtendo alta em até 2 dias. Nas avaliações ecocardiográficas do seguimento em 6 e 12 meses, não houve migração do dispositivo, presença de trombos e nem vazamentos peridispositivo. Na evolução clínica aos 12 meses, nenhum dos pacientes apresentou eventos tromboembólicos ou sangramentos relacionados aos fatores de risco ou ao dispositivo. Nesta pequena série, a OAAE mostrou-se segura, com uma alta taxa de sucesso do procedimento e evolução favorável dos pacientes aos 12 meses. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Left Atrial Appendage Closure with Amplatzer Cardiac Plug in Nonvalvular Atrial Fibrillation: Safety and Long-Term Outcome.

BACKGROUND: Atrial fibrillation (AF) is a cardiac arrhythmia with high risk for thromboembolic events, specially stroke. OBJECTIVE: To assess the safety of left atrial appendage closure (LAAC) with the Amplatzer Cardiac Plug for the prevention of thromboembolic events in patients with nonvalvular AF. METHODS: This study included 15 patients with nonvalvular AF referred for LAAC, 6 older than 75 years (mean age, 69.4 ± 9.3 years; 60% of the male sex). RESULTS: The mean CHADS2 score was 3.4 ± 0.1, and mean CHA2DS2VASc , 4.8 ± 1.8, evidencing a high risk for thromboembolic events. All patients had a HAS-BLED score > 3 (mean, 4.5 ± 1.2) with a high risk for major bleeding within 1 year. The device was successfully implanted in all patients, with correct positioning in the first attempt in most of them (n = 11; 73.3%). CONCLUSION: There was no periprocedural complication, such as device migration, pericardial tamponade, vascular complications and major bleeding. All patients had an uneventful in-hospital course, being discharged in 2 days. The echocardiographic assessments at 6 and 12 months showed neither device migration, nor thrombus formation, nor peridevice leak. On clinical assessment at 12 months, no patient had thromboembolic events or bleeding related to the device or risk factors. In this small series, LAAC with Amplatzer Cardiac Plug proved to be safe, with high procedural success rate and favorable outcome at the 12-month follow-up. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0).